Oral Bisphosphonates Fosamax, Actonel, Boniva and Side Effects: Helpful Food and Nutrition Tips

Editor's Note: This article was originally written by patient expert Rose Chon.

Treatments for osteoporosis include a variety of medications (bisphosphonates, estrogen/hormone therapy, selective estrogen receptor modulators or SERMs), as well as calcium and vitamin D supplements. Some of these medications may not be as effective if they are not taken properly. Oral bisphosphonates for osteoporosis in post-menopausal women (Fosamax, Actonel, Boniva), in particular, must be taken once a week or once a month first thing in the morning   and on an empty stomach to avoid food interactions.

Under FDA guidelines, drugs to treat osteoporosis must be shown to preserve or increase bone mass as well as maintain bone quality in order to reduce the risk of experiencing broken bones or fractures. Some medications increase bone thickness or slow the rate of bone loss.

These drugs, like most medicines, have some side effects and the potential for food-drug interactions. While it is a difficult and complex problem to determine the exact effects of food and nutrients on a particular drug, there can be dramatic results or problems caused by food-drug interactions, as well as drug-drug and alcohol-food-drug interactions.


Although not all medicines are affected by food, some are affected by what you eat and when you eat it. For example, consuming some medicines at the same time that you eat may interfere with the way your body absorbs the medicine. The food may decrease and even delay the absorption of the drug.


Let's begin by taking a closer look at a few popular osteoporosis drugs used to prevent or treat osteoporosis.


These drugs are in a group of medicines called bisphosphonates, which can inhibit bone breakdown, preserve bone mass, and even increase bone density in your spine and hip, reducing the risk of fractures.All three drugs should be taken first thing in the morning; Actonel and Fosamax should be taken at least 30 minutes before you eat or drink anything or take any other medicine and Boniva should be taken at least 60 minutes before you consume any other food, drink or medicine. Take the tablet with a full glass (6 to 8 ounces) of water. Use only plain water, not mineral water, coffee, tea, juice, milk, or other dairy products.

After taking Actonel or Fosamax, do not go back to bed, lie down or recline for at least 30 minutes after you take the tablet. Do not eat anything or drink anything other than plain water; do not take any other medicines including vitamins, calcium, or antacids for at least 30 minutes after taking the tablet. For those who take Boniva, make sure you wait at least 60 minutes before lying down or reclining or eating or drinking anything, including vitamins, calcium, or antacids.

Some possible side effects of these drugs include: mild heartburn or upset stomach, diarrhea, gas, constipation, acid regurgitation, and indigestion. Please note this is not a comprehensive list of side effects and other side effects may also occur, so please talk to your doctor about any side effect that seems unusual or that is especially bothersome.


Many popular osteoporosis drugs, including Fosamax, Actonel and Boniva, cause stomach and esophageal irritations. One way to combat these side effects is to modify your diet by eating milder foods and avoiding certain foods that may further irritate the condition.  


To reduce your risk of heartburn and upset stomach, avoid large meals. Your stomach works long and hard to process big meals, which means it must produce a lot of acid. Also, after you eat, do not lie down right away. If you do, you are more likely to have heartburn because gravity is now preventing food from going speedily to the intestines.

You may also want to try sleeping with your head and shoulders propped up 6 to 8 inches, so that your body is at a slight angle. This gets gravity working for you and not against you. As a result, digestive juices in your stomach are then more likely to head south, for your intestines, instead of back up into your esophagus to cause a burning sensation.

Try to eat your last full meal at least three hours before bedtime. When you go to sleep, everything slows down, including your digestive system, so food you ate right before bedtime will stay in your stomach longer.

Avoid foods that contain a lot of acid, such as citrus fruits and tomatoes, and any other food that gives you problems. Consider also cutting down on caffeine because it triggers acid production in your stomach. Caffeine-heavy items include coffee, tea, chocolate, and some sodas.

Cut down on alcohol and smoking. Both irritate the lining of your stomach and tend to lower esophageal sphincter pressure. When this happens, it is easier for the acid in the stomach to shoot back up your esophagus.

These are just a few helpful tips, but remember, if you experience side effects and are not sure what to do or have questions, contact your doctor, pharmacist, or other health care provider.

Foods and Beverages That Can Irritate Your Stomach

  • Fried foods
  • Fatty foods
  • Citrus fruits
  • Tomato products
  • Coffee
  • Alcoholic beverages
  • Citrus fruit drinks
  • Chocolate
  • Peppermint
  • Pepper

Stomach-Friendly Foods


  • Apple (fresh, dried, juice)
  • Banana


  • Baked potato
  • Broccoli
  • Cabbage
  • Carrots
  • Green beans
  • Peas


  • Ground beef, extra-lean
  • Steak, London broil
  • Chicken breast, skinless
  • Egg whites
  • Egg substitute
  • Fish, no added fat


  • Cheese, feta or goat
  • Cream cheese, fat-free
  • Sour cream, fat-free
  • Soy cheese, low-fat


  • Bread, multi-grain or white
  • Cereal, bran or oatmeal
  • Corn bread
  • Graham crackers
  • Pretzels
  • Rice, brown or white
  • Rice cakes